AB0629 Glomerulonephritis associated with ANCA after COVID-19 vaccine: a systematic review
Authors: A. Laskova, B. Mohammed, F. Ali, B. Syritsa
Journal: Annals of the Rheumatic Diseases (2022)

Background The COVID-19 pandemic has led to widespread vaccination with effective results and a great safety profile. However, as the vaccination rate has increased, more cases of autoimmune diseases after the COVID-19 vaccine have been described. We present a systematic review of ANCA-associated glomerulonephritis after the COVID-19 vaccine. Objectives To summarize the existing evidence on ANCA-associated glomerulonephritis after the COVID-19 vaccine. Methods We searched all studies from inception till January 27, 2022, that described ANCA-associated biopsy-proven glomerulonephritis after COVID-19 vaccine through Embase and Medline. Methodological quality was evaluated with the 4 domains tool. We included 13 patients from 2 case series and 9 case reports. We extracted demographics, history, lab results, outcomes. We then applied descriptive statistics. Results 46% of the patients were males and 54% were females. The median age was 74 years. 54% developed symptoms after the second dose of the 2-dose vaccine. The median interval between the vaccine and the symptom onset was 10.5 days. 85% had anti-MPO antibodies, and the rest – anti-PR3 antibodies. 31% of patients had persistent creatinine (Cr) elevation on follow-up, and 3 patients were requiring hemodialysis. Of those 3 patients, 1 patient had normal renal function prior to presentation, and the rest had chronic kidney disease. The summary of the cases is presented in Table 1. Table 1. Gender, age De novo (1) or relapse (2) AZD1222 (1), or mRNA-1273 (2), or BNT162b2 (3) Outcome M, 75 1 2 1 Hemodialysis M, 74 1 2 1 Improved Cr F, 82 2 1 2 Improved Cr F, 70 3 1 2 Improved Cr F, 78 4 1 3 Improved Cr F, 79 5 1 3 Remission F, 54 6 1 3 Improved Cr F, 78 6 2 3 Hemodialysis M, 58 7 1 2 Remission M, 63 8 1 1 Improved Cr F, 29 9 1 3 Remission M, 52 10 1 2 Hemodialysis M, 84 11 1 3 Worsened Cr Conclusion Although the causality cannot be established on current evidence, the COVID-19 vaccine can probably trigger glomerulonephritis associated with ANCA, primarily anti-MPO type. We need a bigger cohort to identify patients predisposed for disease development or relapse after the COVID-19 vaccine. References [1]David R, Hanna P, Lee K, et al. Relapsed ANCA associated vasculitis following Oxford AstraZeneca ChAdOx1-S COVID-19 vaccination: A case series of two patients. Nephrol . 2021;27(1):109-110. [2]Klomjit N, Alexander MP, Fervenza FC, et al. COVID-19 Vaccination and Glomerulonephritis. Kidney Int Rep . 2021;6(12):2969-2978. [3]Chen C-C, Chen H-Y, Lu C-C, et al. Case Report: Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis With Acute Renal Failure and Pulmonary Hemorrhage May Occur After COVID-19 Vaccination. Front Med . 2021;8. [4]Shakoor MT, Birkenbach MP, Lynch M. ANCA-Associated Vasculitis Following Pfizer-BioNTech COVID-19 Vaccine. Am J Kidney Dis . 2021;78(4):611-613. [5]Hakroush S, Tampe B. Case Report: ANCA-Associated Vasculitis Presenting With Rhabdomyolysis and Pauci-Immune Crescentic Glomerulonephritis After Pfizer-BioNTech COVID-19 mRNA Vaccination. Front Immunol . 2021;12. [6]Davidovic T, Schimpf J, Sprenger-Mahr H, et al. De Novo and Relapsing Glomerulonephritis following SARS-CoV-2 mRNA Vaccination in Microscopic Polyangiitis. Case Reports Nephrol . 2021. [7]Feghali EJ, Zafar M, Abid S, et al. De-novo Antineutrophil Cytoplasmic Antibody-Associated Vasculitis Following the mRNA-1273 (Moderna) Vaccine for COVID-19. Cureus . 2021;13(11). [8]Villa M, Diaz-Crespo F, Perez de Jose A, et al. A case of ANCA-associated vasculitis after AZD1222 (Oxford–AstraZeneca) SARS-CoV-2 vaccination: casualty or causality? Kidney Int . 2021;100(4):937-938. [9]Dube GK, Benvenuto L, Batal I. Antineutrophil Cytoplasmic Autoantibody-Associated Glomerulonephritis Following the Pfizer-BioNTech COVID-19 Vaccine. Kidney Int Rep . 2021;6(12):3087-3089. [10]Sekar A, Campbell R, Tabbara J, et al. ANCA glomerulonephritis after the Moderna COVID-19 vaccination. Kidney Int . 2021;100(2):473-474. [11]Obata S, Hidaka S, Yamano M, et al. MPO-ANCA-associated vasculitis after the Pfizer/BioNTech SARS-CoV-2 vaccination. Clin Kidney J . 2021. Disclosure of Interests None declared